Insurance company denied request for an MRI

My Proton therapy treatment had to be appealed twice. The third time it went across their desk....it was approved. (I ended up not using it)

So keep appealing.

On a personal note dbell.....this stuff doesn't stop me. It's wrong for some insurance wonk to presume they know better than a specialist from a world-renowned cancer treatment center as to what is the best course of treatment for a cancer patient. That just don't float my boat. I don't care what the fine print says. It pisses me off just reading about it.

If it's denied again.....submit again. The squeaky wheel gets the grease.

I think if that happened to me ... I wouldn't be above calling my lawyer and having him type up a letter putting the insurance company on notice that if this cancer isn't treated as MSKCC's experts says it should be....it's on them. 100 per cent. But I'd exhaust every option before doing that. That's the doomsday scenario. Maybe your doctor knows how to word it differently. Keep submitting.....don't stop.

That's me.

good luck I think you'll get the scan

Someone at that insurance company has the latitude to approve that test. It's just a matter of getting through the front door.....and letting them know....it's worth their while.

Just to add to what Tall Allen said,

"transperineal template-guided prostate mapping biopsy"

"A procedure .... in the diagnosis of prostate cancer and in planning prostate cancer treatment. Ultrasound is used to create a map of the prostate so the whole prostate gland can be seen in three dimensions and divided into 24 areas. Needles are then inserted through a template into each of the 24 areas and tissue is removed to be checked under a microscope. Also called TTMB."

No needles through the rectum. Under sedation, guided needles go through the skin in front of the rectum into the prostate. No ambiguity as to what is shown on an MRI image. Provides actual biopsy tissues for pathology examination and evaluation of absence or presence of cancer, gleason scores, etc.

Charles